The Young and the RA

So. I’m in the middle of a little scare here, which kind of relates to a topic that one of my loyal readers wanted me to talk about: Drinking and RA.

My liver is dying at the moment. Well, maybe not, but I’m a little worried about it. Anyone on methotrexate should know that the drug is really hard on your liver. (If your doctor has not told you this, talk to her/him. If she/he doesn’t know anything about its effects, find a new doctor because yours isn’t good enough to treat someone as special as you.)

So, when I was first put on methotrexate, they had me on 15 mg. Then I started having problems with fatigue (meaning I was in need of even more than the usual 10 hours I currently have to get to function properly) and hair loss (I was shedding like a cat) and had to lower my dose. I am now on 7.5 mg — a fairly low dose — and there has been talk of reducing it soon. (Cross your fingers!).

Now the bad part. Because methotrexate is so hard on your liver you have to waaaayyyyy lower your alcohol consumption, which is nearly impossible as a college student (well, not impossible, but no fun whatsoever). But I sucked it up and have tried to be as good as possible since then. Supposedly you should only have one alcoholic drink a month, but I fudge that number a little. (I hope my doctor isn’t reading this!!!) But I am not getting trashed every night or anything close by any means. I am good about it. I promise. (And I recommend you try to stick to the one drink limit as well as you can, too!) I have been especially good the past several weeks because of this liver scare.

I was having stomach-cramping-style pains and went in to see a doc while visiting sunny California this week. (Just as beautiful as I remember it. This time I may not leave. What does half of a Masters get you?) So while the doc was examining me he discovered that my liver is tender (AHHHHH!!!!). So now I am freaking out about that. I’m getting the blood work done today, and I am just hoping it comes out clean.

People taking methotrexate are suppose to have blood work done on a regular basis (every few months) to test their liver functions (there are several). If you aren’t currently getting blood work done, get it. They need to make sure your liver is functioning properly and the methotrexate isn’t killing it like it may have killed mine! Drinking alcohol can speed up the destruction.

If you are taking methotrexate and drink, there are a few things you’ll want to do. One is drink TONS of water. Helps to protect the liver. Also, never take methotrexate on the day you are drinking, take it as far away from a drink as possible. I take mine on Wednesday night so that I don’t have to worry about weekend drinks.

I also take lots of water the day before and after taking the drug. Water is the key!!! So protect your liver. Don’t end up in the doc office freaking out about your tender liver like I am! Anyways, I’ll let you know what the test says. Wish me luck! 

Until next time,

S.P. 

“A large study conducted in Canada reveals that patients who are treated for rheumatoid arthritis (RA) with the drug cyclophosphamide may have an increased risk for developing hematological cancers such as lymphoma” (CancerConsultants.com). 

Cyclophosphamide is an immunosuppressant that belongs to a class of drugs known as alkylating agents, which were, ironically, originally developed and are still used to treat some types of cancer. Like most RA drugs, cyclophosphamide can increase your risk for infections. It is because of this susceptibility for infection that researchers worry that immunosuppressant drugs may increase one’s risk for developing certain types of cancers such as lymphoma.

The purpose of the 23,810-person study was to determine if anti-rheumatic drugs, such as cyclophosphamide, were associated with risks for certain cancers. During the study:

• “619 patients developed cancers of the blood or lymph systems
• 346 patients developed lymphoma
• 178 patients developed leukemia
• 95 patients developed multiple myeloma
• The most frequently used drugs included methotrexate, azathioprine, and cyclophosphamide. Only cyclophosphamide, however, was associated with an increased risk for lymphoma” (CancerConsultants.com). 

According to the article, the results indicated that though immunosuppressant drugs might increase the risk for blood or lymph system cancers (UMMMMM…WHAT!), cyclophosphamide showed the greatest risk for lymphoma. Just hearing that freaked me out.

I take BOTH methotrexate AND azathioprine (also known as Imuran). So is there something else I should be monitoring? And I always thought of these drugs as ones that fight cancer since most of them started as cancer drugs, so this seems so out of left field to me. I’m going to have to do some more research and ask my rheumatologist about it. But just tell me this study doesn’t freak you out?! I don’t want to wake up 10 years down the road and find out these meds that I thought were helping are actually going to kill me. It’s kinda of a Catch-22. Scary.

Until next time,

S.P. 

Today I am going to tell you about one of the most basic drugs used to help with RA inflammation: NSAIDs. It is often the first drug a doctor will prescribe when you come in complaining of joint pain. I know I took a large dose of Advil, prescription strength naproxen and Celebrex before being officially diagnosed with RA. It is important to know what NSAIDs do so that you can understand their effect on your body.

Nonsteroidal anti-inflamatory drugs (NSAIDs) are used to reduce inflammation in the body. Over the counter examples would be Advil and Aleve. A prescription strength version would be Celebrex. They work to suppress enzymes called Cox-1 and Cox-2, also called cyclooxygenase. They produce a family of chemicals called prostaglandins. Prostaglandins promote inflammation, pain and fever, support the function of platelets (which are used in blood clotting), and protect the stomach lining from the effects of acid.

NSAIDs block Cox enzymes and reduce prostaglandins in the body thus reducing ongoing inflammation, pain and fever. But because cyclooxygenase also protects the stomach and support platelets, NSAIDs can cause ulcers and promote bleeding.

It is important to note that NSAIDs only treat the pain caused by RA inflammation and don’t treat the disease itself. I haven’t found much relief using them, but you may. I have found that prednisone works better for me when I have joint inflammation. But try them out. Just make sure to talk to your doctor if you take more than the amount prescribed on the bottle.

Until next time,

S.P.